| Theme | Perspective for Chemotherapy in Gastrointestinal Malignancy Based on Current Evidence | |
|---|---|---|
| Title | New Treatment Strategy of Gastrointestinal Stromal Tumor | |
| Publish Date | 2013/03 | |
| Author | Akira Sawaki | Department of Oncology, Japan Red Cross Nagoya Daini Hospital |
| [ Summary ] | Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. The development of GISTs is driven by the mutated c-kit or PDGFRA gene. Discoveries in molecular pathogenesis have provided us with effective targeted therapies which selectively inhibit etiologic driver pathways, leading to dramatically improved clinical outcomes. In this review, we discuss the highlights of adjuvant chemotherapy and new agents for GIST therapy. Recently reported results of the SSG XVIII/AIO trial represent a significant change in the evidence for adjuvant therapy. Adjuvant therapy with imatinib at 400 mg/day for 3 years is a standard treatment following resection of high risk GISTs. Adjuvant therapy for other risk patients may be considered on a case-by-case basis in reference to recurrent risk. Reinitation of imatinib therapy may be proposed for patients for whom we have discontinued adjuvant imatinib therapy. Treatment is not recommended for those who are imatinib-insensitive with D842V-mutated GIST. Patients should be assessed at 6-month intervals after initation of treatment. An international phase III, randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of regorafenib. The hazard ratio for progression-free survival (PFS) and overall survival (OS) was 0.27 and 0.77, respectively. Regorafenib was well tolerated and significantly improved PFS and OS in patients with GIST after failure of prior imatinib and sunitinib treatment. |
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